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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:613-4 - Vol. 70 Num.07 DOI: 10.1016/j.rec.2017.01.028

Radiation Exposure to the Pregnant Interventional Cardiologist. Is It Really Necessary?

Irene Valverde André a,, Rocío Cózar León b, Mar González Vasserot a, Ernesto Díaz Infante b

a Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
b Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen Macarena, Sevilla, Spain

Refers to

Radiation Exposure to the Pregnant Interventional Cardiologist. Does It Really Pose a Risk to the Fetus?
Maite Velázquez, Marta Pombo, Leire Unzué, Teresa Bastante, Elena Mejía, Agustín Albarrán
Rev Esp Cardiol. 2017;70:606-8
Full text - PDF
Radiation Exposure to the Pregnant Interventional Cardiologist. Is It Really Necessary? Response
Maite Velázquez, Marta Pombo, Leire Unzué, Teresa Bastante
Rev Esp Cardiol. 2017;70:614-5
Full text - PDF

Article

To the Editor,

We read with great interest the article by Velázquez et al.1 on radiation exposure in pregnant interventional cardiologists and we would like to congratulate the authors on their thoroughness. However, there are some issues that we would like to comment on.

First, the authors state that concern about ionizing radiation exposure during pregnancy can mean a 1-year interruption to the cardiologist's career. However, most cardiac catheterization and electrophysiology sections have more than one cardiologist,2, 3 and therefore in many cases the female worker can avoid exposure with a simple redistribution of tasks. This could, however, mean excess work load for the other members of the department unless maternity leave is covered by an interventional cardiologist. In addition, when the same department has 2 cardiologists who both wish to have children at a similar time, it may be (and often is the case) that they have to coordinate their pregnancies, although this is not always feasible for biological reasons.

Second, the authors assert that it is possible to work in the catheterization laboratory with a practically negligible risk if appropriate precautions are taken. We firmly defend the right of the workers to decide, rather than subjecting them to the dictates of Occupational Health and Safety, but we are concerned that there are no controlled clinical studies and that most of the data are extrapolated from animal studies. If we draw a parallel with drugs, most are not recommended during pregnancy because they have been tested only in animals, and the risk (however “negligible”) is only accepted when there is a medical reason. However, in the case of workplace exposure to radiation, the risk is accepted with no medical reason, which goes against the recommendations of Occupational Health and of the obstetrician, as well as the father's obvious reluctance. Furthermore, as the authors mentioned, the probability of spontaneous congenital malformation or childhood cancer is 4.07%. When this occurs, if the mother has been exposed to radiation, even if the dose received has been minimal and in theory the risk is negligible, it is likely that an explanation will be required, or demanded.

The article describes the protection used by exposed female workers. Two of them used additional material (1 of them up to 3 lead skirts), from which we can deduce that they did not feel safe with the standard protective equipment. Furthermore, it is often forgotten that pregnancy constitutes a situation of particular risk that predisposes to worsening of varicose syndromes and musculoskeletal problems due to the change in lumbar curvature and weight gain: use of skirts and vests (not to mention additional material) further aggravates this risk. We suggest that it would be preferable to invest in other protection methods, such as navigation systems, with which multiple substrate ablations can be performed without fluoroscopy,4 and, above all, the use of complete protection screens (eg, hood-type) that are used in Europe, which avoid the need for vests and aprons and their associated problems.

Last, we wonder whether female interventional cardiologists feel completely free when deciding not to modify their activity during pregnancy. As we all know, working conditions have deteriorated in recent years and such decisions may be affected by the high rate of temporary contracts, up to 40% in the public health system.5

Therefore, until controlled studies in this setting are published, instead of burdening the female worker with the responsibility for this decision, we believe that it would be more appropriate to focus on adequately equipping laboratories with complete radiological protection methods, which in addition would benefit all exposed workers.

CONFLICTS OF INTEREST

R. Cózar León declares having received payments from Boston Scientific for giving lectures.

E. Díaz Infante declares having received payments from Boston Scientific, St Jude Medical, Medtronic, and Biotronik for giving lectures and educational presentations.

Corresponding author: irene.valverde.andre@gmail.com

Bibliography

1. Velázquez M, Pombo M, Unzué L, et al. Exposición de las cardiólogas intervencionistas a radiaciones ionizantes durante el embarazo. ¿Realmente representa un riesgo para el feto?. Rev Esp Cardiol. 2017;70:606-8.
2. Jiménez-Quevedo P, Serrador A, De Prado AP, et al. Registro Español de Hemodinámica y Cardiología Intervencionista. XXV Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2015). Rev Esp Cardiol. 2016;69:1180-9.
3. Pedrote A, Fontenla A, García-Fernández J. Registro Español de Ablación con Catéter. XV Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2015). Rev Esp Cardiol. 2016;69:1061-70.
4. Álvarez M, Bertomeu-González V, Arcocha MF, et al. Ablación con catéter no guiada por fluoroscopia. Resultados de un registro prospectivo multicéntrico. Rev Esp Cardiol. 2016. http://dx.doi.org/10.1016/j.recesp.2016.09.022
5. Informe de resultados del estudio sobre la situación laboral de los médicos en España. Madrid: Organización Médica Colegial;2016 [accessed 2 Jan 2017]. https://www.cgcom.es/sites/default/files/u183/InformeResultadosTercerMuestreoEncuestaSituaci%C3%B3nLaboraldelosM%C3%A9dicosenEspa%C3%B1a30demarzode2016.pdf.

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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